The goals of knee arthroplasty are to relieve joint pain, improve joint function, correct joint deformity, and achieve long-term stability. The main indications include.
1, osteoarthritis of the knee (OA): Geriatric knee OA accounts for the largest proportion of total knee replacements.
2, advanced knee lesions in rheumatoid arthritis (RA) and ankylosing spondylitis (AS): RA or AS can often involve bilateral knee joints.
3. Other non-infectious arthritis causing knee lesions with pain and dysfunction. Such as large osteoarthrosis, hemophilic arthritis, etc.
4, traumatic osteoarthritis: osteoarthritis after severe trauma involving the joint surface, such as cases where the joint surface fails to repair after a comminuted plateau fracture and severely affects function, as well as secondary osteoarthritis due to meniscal injury or after resection.
5, cases with large osteochondral necrosis or other lesions of the knee joint that cannot be repaired by conventional surgical methods.
6.Joint destruction following infectious arthritis can be a relative indication for TKA if no active infection is confirmed.
7. Cases in which good joint function reconstruction cannot be obtained after resection of tumors involving the knee joint surface. Such cases may require a special customized prosthesis.
In conclusion, the indications for total knee arthroplasty are broad, but it does not mean that this procedure can be abused. It remains important to be strict about the indications for the procedure and to consider the age of the patient undergoing TKA.
Functional rehabilitation after knee arthroplasty is an important part of the outcome of the procedure. All rehabilitation exercises should be performed under the principle of painlessness. The following methods can be referred to.
1. Exercises for knee extension and flexion.
Leg compression exercises to straighten the function: patients with knee flexion contracture deformity, take a standing or lying position, heel placed on a soft pad of about 30 cm, their own or others hands placed on the distal end of the thigh, uniform continuous force pressure to the back of the knee joint pulling sensation and pain when maintained for 3 min, alternating between the two legs, 5 times a day.
Sitting knee flexion exercises: The patient sits on the edge of the bed with the legs hanging down naturally and the flexors contracting to gradually flex the knee joint.
Reclining knee flexion exercise: the patient takes a flat position, the heel of the foot moves toward the hip to drive the knee joint to flex.
Wall climbing exercise: The patient’s buttocks face the head of the bed, the affected limb is raised, and the weight of the limb or the foot is used to climb on the wall to help knee flexion. And you can draw a line on the wall to record the progress.
2. Quadriceps isometric or isotonic contraction exercises.
Active knee straightening:The patient takes a sitting position with hands propped back or back against the wall, the physical therapist places one hand below the knee joint and one hand on the inner top of the distal thigh, asking the patient to extend the knee and tense the thigh muscle, both hands feel the pressure under the knee and the contraction of the medial head of the quadriceps to evaluate the strength of the muscle. The contraction is maintained for 20 seconds each time, 10 times as a group, and 10 buttons can be taken out of the box in stages to keep count. Practice 3-5 sets per day.
Active straight leg raise: in the knee joint active extension of the lower limb raised to the heel from the bed about two fists high, the same maintained for 10 seconds each time. If you can easily complete 5 sets of exercises per day (no muscle soreness and pain after completion), you can add sandbags to the ankle to strengthen muscle strength, sandbags from half a pound, according to each person’s ability to gradually increase, each time increasing half a pound, to three pounds to stop increasing the weight. Further strengthening of muscle strength can be accomplished by increasing the number of sets of exercises per day or exercises such as weighted squats.
The patient sits on the edge of the bed and performs active knee flexion and extension exercises, paying attention to straightening the joint as much as possible when extending the knee. 20 times is one set, 3-5 sets per day, easily complete the daily exercise sets, you can tie sandbags to the ankle to strengthen the muscle strength, the same method as above. Other muscle isometric or isotonic contraction exercises each contraction maintenance time, the number of times per group, the number of groups per day are the same as this.
3, squat exercises.
Weighted squat. 50-100 times / day (to the principle of no pain in the knee joint)